Summaries of health policy coverage from major news organizations

Democrats Criticize AHP Bill

In debate over a proposed association health plan bill (S 1955), Senate Democrats on Wednesday said the measure would eliminate state health care coverage requirements, potentially jeopardizing women's access to contraceptives and leading to more abortions, the Washington Times reports (Fagan, Washington Times, 5/11).

The bill, sponsored by Senate Health, Education, Labor and Pensions Committee Chair Mike Enzi (R-Wyo.), would allow small businesses and trade associations to form association health plans across state lines. Under the bill, insurers would be permitted to sell plans to businesses and individuals that do not meet current state benefits requirements.

However, they then also would have to offer a plan with benefits provided under a state employees' plan in one of the five most heavily populated states -- California, Florida, Illinois, New York and Texas. In addition, the bill would preempt state laws that limit how much insurers can vary premiums from one small business to another (California Healthline, 5/10).

Some Democrats said that waiving state coverage requirements would lead to harmful reductions in key areas, such as contraception, which they said is required coverage in about 25 states.

Senate Minority Leader Harry Reid (D-Nev.) said, "If Bush Republicans have their way, millions of women will have to make a choice between going without effective prescription contraception and struggling to pay for it out-of-pocket, something many will be unable to do."

Sen. Hillary Rodham Clinton (D-N.Y.) said, "[I]n order to decrease the number of unintended pregnancies and to decrease the number of abortions, we must make contraception more accessible and more affordable."

Reid and Rodham Clinton argued that the bill would have the opposite effect.

Enzi Reaction

Enzi said the Democrats' arguments were "fear-mongering in its most transparent form." Enzi said access to contraceptives is protected under federal rulings, which the bill would not affect (Washington Times, 5/11). He added that Reid and Rodham Clinton have come to an "outrageous conclusion" that is "clearly another attempt by opponents of this bill to tarnish it with falsehoods and misrepresentation."

Snowe Amendment Impact

Democrats and abortion rights group NARAL Pro-Choice America said an amendment to the bill offered by Sen. Olympia Snowe (R-Maine) would not resolve the issue. Under Snowe's amendment, the health plans would keep coverage for conditions that at least 26 states require insurers to provide.

Democrats and NARAL said only 25 states mandate coverage of contraception. Snowe and the Council for Affordable Health Insurance argued that 30 states require contraception coverage, which would leave the mandate in place if the amendment is adopted. Both sides said there are differences in how contraceptive coverage is defined, causing the discrepancy (Schuler, CQ Today, 5/10).

Bill Progress

According to the Times, progress on the bill has been slow. Senate leaders plan to bring up a cloture motion Thursday to end debate and force a final vote on the measure soon. However, a Democratic leadership aide said Democrats would vote against cloture (Washington Times, 5/11).

In addition, Republican leaders planned to put the measure on hold as they spend eights hours of floor time on Thursday on the $70 billion tax reconciliation conference report. The delay could push debate over the bill into next week, according to Enzi.

Republican leaders also are determining which amendments to the bill would be permitted after Senate Majority Leader Bill Frist (R-Tenn.) "filled the amendment tree" on Wednesday to prevent Democrats from offering amendments on other health care topics, including extending the Medicare drug benefit deadline and stem cell research, CongressDaily reports.

Frist said, "There has been a suggestion that this bill would be a Christmas tree for all kinds of amendments ... that won't relate to the underlying bill" (Heil, CongressDaily, 5/11). He said amendments would be limited to those "directly related" to the bill.

However, Reid said there might be an opportunity for Democrats to offer amendments if Enzi approves of them. He also said he did not think the bill could be changed enough to win adequate Democratic support to gain the 60 votes necessary to limit debate (Heil, CongressDaily, 5/10).

Massachusetts Concern

According to the Boston Globe, the Enzi bill "could undercut the new universal health insurance law in Massachusetts, by freeing insurers to brush aside state-required benefits and to charge older and sicker residents far higher premiums." The Enzi bill states that it "shall supersede any and all state laws" regarding mandated health coverage, the Globe reports.

Sen. Edward Kennedy (D-Mass.) said that the bill could set back the state's efforts to achieve universal coverage because older residents and those with major health issues could be priced out of the insurance market and insurers could offer subpar coverage. He said, "We (in Massachusetts) have passed a good bill that will cover all the people in our state, no matter what their illness, no matter what their sickness. This legislation on the floor of the ... Senate would effectively undermine that, and kill that legislation."

John McDonough, executive director of Health Care for All, said the Enzi bill would allow insurers to charge a company with an older and sicker workforce up to 26 times the amount it would charge one with a younger and healthier workforce. He said that coverage would be too expensive for many workers to afford.

However, some specialists predicted the impact on the Massachusetts law would be minimal.

Jonathan Gruber, a health care economist at the Massachusetts Institute of Technology, said bare-bones insurance policies are not popular with employers and would not take hold in Massachusetts if they became legal. Gruber added, "There's just not a lot of demand for stripped-down insurance. I don't see it being the death knell of this plan by any stretch."

If the Enzi bill passes, the right of the federal government to preempt state statutes "will almost certainly be fought in court," the Globe reports (Klein, Boston Globe, 5/11).

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